1.  Name of applicant:           Date:

2. Street address:                 City:         State:         Zip:  

3.  Main Contact Number:            Alternate Number:

4.  Email Address:       Age:  

    How long have you lived at this address:  Less Than 1 Year 1 - 2 Years More Than 2 Years

5.  Are you adopting for yourself or for someone else:  

6.  Describe in detail the dog you’re looking for or the name of the Paw Pals animal(s) you are interested in:

7.  Will this be your first dog?  Yes No

8.  What kind of pets have you had in the past? 

9.  Which of these do you still have? (include age, sex and breed):

10.  Have they been spayed or neutered?  Yes No      Are they current on vaccinations?  Yes No

11.  What happened to the pets you no longer have? 

12.  Have you ever surrendered your dog in to a shelter?  Yes No     if yes, please explain:

13.  Have you ever had a pet euthanized?  Yes No     If yes, please explain:

14.  If you have pets, will they adjust to a new dog in the house?  Yes No Don't Know         Was your last dog obedience-trained?  Yes No

15.  Why do you want this dog? (check all that apply)  Companion  Companion for other pet  House pet  Watch dog  Guard dog

Hunting dog  Personal protection  Other 

16.  How many adults are in your family? How many children?    Children’s ages?

17.  Does any member of your household have an allergy to dogs?  Yes No

18.  Is someone home during the day?  Yes No     If  yes, who? 

19.  How many hours each day will the dog be without human companionship?

Please explain: 

20.  Where do you live?  House Apartment Condo Mobile Home Other         Other explain:

21.  Do you own or rent your home?  Own Rent     If you rent, may we contact the owner to obtain permission for this dog to live in your home?  Yes No

22.  Owner’s name and phone number 

23.  Do you have a completely fenced yard?  Yes No        Is there a gate?   Yes No

24.  What kind of fence?                   Height of the fence

25.  If no fenced yard, please explain: 

26.  Do you have a dog door?   Yes No         Will there be times when the dog will be tied up?  Yes No         If yes, when:

27.  Will the dog spend any time in the garage?   Yes No      If yes, please explain: 

28.  Do you have a pool?  Yes No         If yes, is there a fence around the pool?  Yes No

29.  What kind of fence?           Height of the fence: 

30.  If your new dog/puppy is not housebroken, what method will you use to train him/her?

31.  Will you keep the dog up to date on vaccinations?  Yes No     if no, please explain: 

32.  Who is your veterinarian?          Phone:      City/State: 

33.  Are you able and willing to exercise the dog on a regular basis?  Yes No     If yes, method of exercise: 

34.  Where will the dog be kept during the day?            At night? 

35.  If you drive a pickup truck, would you allow the dog to ride in the truck bed?  Yes No     If yes, please explain:

36.  If you go away for a few days, or on a vacation, who will take care of the dog?

37.  What arrangements will you make for the care of your pets in case of an emergency? 

38.  If you move, will you take the dog with you?  Yes No     If no, please explain:

39.  Have you ever applied to Paw Pals before to adopt an animal?  Yes No     If yes, ,when: 

40.  Have you ever brought animals to Paw Pals?  Yes No     If yes, please explain: 

41.  Are you willing to have a representative of Paw Pals come to see where the dog will be living?  Yes No     If no, explain: 

42.  Are you willing to take responsibility for this dog for the next 10 to 15 years?  Yes No     If no, explain: 

43.  What provisions will you make for the dog should you become unable to care for him/her? 

44.  Please provide two personal references:

Name:           Relationship: 

Street address: 

City:            State:             ZIP: 

Phone:        Email: 

 

Name:           Relationship: 

Street address: 

City:            State:             ZIP: 

Phone:        Email: 

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